EFFECTIVE CONTRACEPTION AND ABORTION
Unquestionably, successful prevention of pregnancy through contraception is much wiser and safer than terminating a pregnancy through abortion. Nevertheless, amidst the accelerated social and economic changes in developing nations, the complete avoidance of a stage of widespread abortion is unlikely. However, there is evidence that highly effective contraceptive programs, designed to reach a sizable proportion of exposed fertile females, can significantly limit the spread and severity of induced abortion. Such programs will also be effective in limiting the prevalence of resort to induced abortion in developed, low-fertility countries.
Ironically, however, when contraceptive programs are instituted, there may be a temporary increase in induced abortions. Whether programs are directed at selected individuals or the community at large, initial failures are frequent, and those who fail often resort to induced abortion. Because a sizable number of women will continue to resort to abortion, policymakers are faced with the task of limiting or minimizing the hazards of abortion for both humanitarian and public health reasons.
The following discussion focuses on two examples: Japan, a posttransi-tional society, and Chile, a transitional society. In both countries conscientious efforts to limit induced abortion have been undertaken.
Japan in the 1950's was confronted with widespread abortion. For every ten women of reproductive age, one or more experienced abortion each year. This problem was widely discussed by experts in demography, economics, sociology, and medicine. The major concern was that large numbers of Japanese women continued to resort to induced abortion despite the availability of improved contraceptive methods.
Intensive educational or "guidance" programs were instituted to promote fertility decline through contraception rather than induced abortion. A report by Koya (11) presents the results of an experimental project in six communities after exposure to 5 years of intensive "guidance" effort. Selected findings of this program are summarized in Table 13. The trends of pregnancies and abortions are depicted in Figure 5. From the original tables and the report, the following observations can be made:
1. The guidance program was intensive and reached a sizable proportion of the couples.
2. There was a pronounced drop in the birth rate, the pregnancy rate, and the induced abortion rate.
3. The trend of decline differed for each rate. There was a progressive drop in the birth rate over the years, indicating a successful combination of contraception and induced abortion. The pregnancy rate began first to in- Families: Family Size and Child Spac-